Know Your Customer (KYC) Form for Legal Person/Legal

Arrangement (To be filled in by the Legal Person/Legal Arrangement

intending to
purchase life & health insurance/family takaful from Jubilee Life Insurance Company
Section A. Identification Details of Legal Person/Legal Arrangement
Full Name of Legal Person/Legal Arrangement:

Date of Incorporation:
Incorporation/Registration Number:
Place of Incorporation:
Name of Registering Authority:
Company Registration Type (Domestic Company/Foreign Company):
Business Address:

Registered Office Address:

National Tax Number:

Sales Tax Number:
Website/Social Media Link:
Legal Form:
□ Listed Company □ Private Company □ Trust □ WAQF □ Partnership □ Cooperative □ NGO
Nature of Business of Legal Person/Legal Arrangement:

Section B. Key Persons

Definition: Directors, CEO, CFO, Chief Risk Officer, Company Secretary, Chief Marketing Officer, Chief Technology
Officer, Chief Compliance Officer, Head of Internal Audit, and/or any other person responsible for the
management of Legal Person/Legal Arrangement.
Note: Kindly provide the information of above-mentioned Key Persons as per attached ("Annexure A") duly signed and
stamped by Authorized Official.

Section C. Ultimate Beneficial Owner (UBO)

Kindly provide the information of Ultimate Beneficial owners (UBOs) as per attached ("Annexure B") duly signed and
stamped by Authorized Official.
Note: An ultimate beneficial owner is a natural person who ultimately owns or controls a company, whether
directly or indirectly, through at least twenty five percent (25%) shares or voting rights or by exercising
effective control in that company.
Please attach attested photocopies of following documents:
1. Certificate of Registration of Legal Person/Legal Arrangement.
2. NTN Certificate of Legal Person/Legal Arrangement.
3. Sales Tax Certificate of Legal Person/Legal Arrangement.
4. CNICs or Passports (in case of non-Pakistani) of all Directors/Trustees/Partners/Shareholders/Owners/UBOs/Persons
responsible for the management of Legal Person/Legal Arrangement.
5. Memorandum and Articles of Association/Bye-laws/Partnership Deed of Legal Person/Legal Arrangement (whichever is
applicable).
6. Certified copies of latest Form A/Form B/Form 29/Form 42/Form 43/Form 45 of Legal Person/Legal Arrangement
(whichever is applicable).
7. Resolution of Board of Directors for opening of Insurance/Takaful Policy Account specifying the person(s) authorized
to open and operate the insurance/takaful policy account.
8. Insurance/Takaful Policy Account opening request on Business Letterhead.

Dated:

Stamp, Name and Signature of Authorized Official:

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Annexure A-Details of Key Persons
CNIC Issue date
CNIC No.
OR
OR
S.No Designation Name Passport Issue Date
Passport No.
(For Foreign
(For Foreign Nationals)
Nationals)

Dated:

Stamp, Name and Signature of Authorized Official:

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Annexure B-Details of Ultimate Beneficial Owners (UBOs). Use separate sheet for each UBO.
1. Name:

2. Father’s Name/Spouse’s Name:

3. CNIC/NICOP/Passport no. along with date of issue (copy attached):

4. Nationality:

5. Country of origin (in case of foreign national or dual national):

6. Usual residential address:

7. Email address:

8. Date on which shareholding, control or interest acquired in the company:

9. Date on which shareholding, control or interest acquired in the company from former ultimate beneficial owner:

10. In case of indirect shareholding, control or interest being exercised through intermediary companies, entities or other legal persons or
legal arrangements in the chain of ownership or control, names and particulars are as follows:

Name Legal form Date of Name of Business Address Country Email address Percentage of Percentage of Identity of Natural
(Company/LLP/ incorporation/ registering shareholding, shareholding, Person who
Partnership registration authority control or control or ultimately owns or
Firm/Trust/ interest of UBO interest of controls the legal
Any other body in the legal legal person or person or
corporate (to be person or legal legal arrangement
specified)) arrangement arrangement in
the Company

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j)

11.Any other information incidental to or relevant to enable the company to evaluate this matter:

And I make this solemn declaration conscientiously believing the same to be true.

This day of , 20 Stamp, Name and Signature of Authorized Official

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